Diabetes, affecting
up to one-third of the population of industrialized countries,
is the most common endocrinologic disorder. Beyond the more
immediately-perceptible metabolic dysfunction accompanying a
typical hyperglycemia, long-term complications of diabetes mellitus
involve disorders of the eyes, kidneys, nerves, and blood vessels.
Due to the widespread prevalence of diabetes and the severity
of its complications, extensive research and development efforts
are underway to find more effective remedies to improve the
quality of life of those affected by the disease. This article
will focus on an integrative approach of the treatment of diabetes
from the perspectives of both western and Oriental medicine.

DEFINITION

Diabetes mellitus
is a chronic endocrinologic disorder characterized by high blood
levels of glucose due to insufficient secretion of insulin by
the pancreas or improper utilization of insulin by target cells.

WESTERN MEDICINE

Diabetes is classified
into two categories: Type I Diabetes, or Insulin-dependent Diabetes
Mellitus (IDDM); and Type II Diabetes, or Non-Insulin-Dependent
Diabetes Mellitus (NIDDM).

Type I, IDDM,
is also referred to as juvenile-onset diabetes, with onset in
the early teen years in many patients. Affected individuals
usually experience an abrupt onset of symptoms, including thirst,
excessive urination, increased appetite, and paradoxic weight
loss. Untreated, symptoms may progress to ketoacidosis and even
coma. Patients secrete little or no insulin, and must rely on
exogenous injections of insulin to control blood glucose levels.
Type I, IDDM, does not respond to prescription drugs, such as
sulfonylurea therapy.

Type II, NIDDM,
is also referred to as adult-onset diabetes, with symptoms appearing
around or after age 40, or into advanced ages, but occasionally
affecting juveniles. Patients with NIDDM are usually obese,
but may show few symptoms or no symptoms in the early stages.
As the disease progresses, patients begin to notice increased
thirst, increased consumption of water and food, excessive frequency
and volume of urination, and other symptoms and signs related
to complications. Patients with NIDDM have normal-to-elevated
levels of insulin secretion, but blood glucose levels remain
high due to insulin resistance. Type II, NIDDM, responds to
both insulin and prescription drug treatments.

Long-term complications
of Diabetes Mellitus affect various tissues and organs. Complications
of damage to blood vessels include poor circulation, delayed
wound healing, heart disease, impotence and gangrene; complications
affecting the eyes include decreased vision and blindness; complications
damaging the kidneys manifest in increased urinary volume and
frequency, and kidney failure; complications in the nervous
system include peripheral neuropathy, sudden or gradual weakness
of a leg, chronic damage to nerves; and complications of the
blood include increased susceptibility to infection, especially
of the urinary tract or skin.

TRADITIONAL CHINESE
MEDICINE

According to Traditional
Chinese Medicine, diabetes mellitus is a disorder characterized
by Yin deficiency with dryness, heat and dampness. Yin deficiency
is the underlying cause of the disease; dryness and heat represent
the symptoms and signs; and dampness is reflected in increased
blood glucose. Diabetes mellitus is most closely related to
Wasting (Xiao Ke) syndrome, which can be categorized into Upper,
Middle and Lower Wasting (Xiao Ke) syndrome, with the organs
affected including the Lungs, Stomach and Kidneys, respectively.

Upper Wasting (Xiao
Ke) Syndrome is characterized by Lung heat drying up body fluids.
Symptoms are fidgeting, polydipsia, dry red tongue (with or
without cracks), with a thin, yellow coat, and a forceful, rapid
pulse (especially at the cun position). Middle Wasting (Xiao
Ke) Syndrome is characterized by Stomach fire damaging fluids,
with such symptoms as polyphagia, constant hunger with good
appetite, red tongue with a yellow coat, and a slippery, forceful,
rapid pulse. Lower Wasting (Xiao Ke) Syndrome is sub-divided
into Kidney Yin deficiency or Kidney Yin and Yang deficiencies.
Kidney Yin deficiency is characterized by symptoms such as polyuria
(especially at night), red tongue with little or no coat, and
a deep, thready, rapid pulse; Kidney Yin and Yang deficiency
is characterized by polyuria (especially at night), teethmarks
on both sides of the tongue, pale red tongue with a white coat,
and a deep, thready, weak pulse.

Despite the similarities
between Diabetes and Wasting (Xiao Ke) Syndrome, it is important
to keep in mind that they are not identical. Both Diabetes and
Wasting (Xiao Ke) syndrome may be characterized by the presence
of the three P's: polyuria, polydypsia and polyphagia. Diabetes,
however, is defined as an increase in blood glucose levels,
with or without the presence of the three P's. In addition,
Diabetes may have many complications not present in Wasting
(Xiao-Ke) syndrome, such as visual disturbances, impotence,
amenorrhea, and frequent infections. Conversely, the presence
of the three P's constitutes diagnosis of Wasting (Xiao-Ke)
Syndrome. Polyuria, polydypsia and polyphagia may be caused
by factors other than diabetes, such as fever, dehydration,
or kidney disease. Understanding the similarities and differences
between the two is essential for an accurate diagnosis and for
optimal treatment of the patient.

Levels above the
acceptable range are considered high, and require treatment.

WESTERN MEDICINE

I. Oral Antidiabetic
Drugs

Oral antidiabetic
drugs are commonly used to treat Type II, NIDDM, patients. There
are three types of oral antidiabetic drugs: sulfonylureas, biguanides,
and glucosidase inhibitors, each with its unique functions and
side effects.

a. Sulfonylureas
are the most common oral antidiabetic drugs. These drugs lower
blood glucose levels by stimulating the pancreas to release
insulin. Patients with Type I, IDDM, do not respond to sulfonylureas
because their pancreas is not capable of producing insulin regardless
of drug stimulation. Despite their effectiveness, sulfonylureas
have unwanted side-effects and toxicity, including nausea, vomiting,
hematological and dermatological reactions, obstructive jaundice,
hyponatremia, and intolerance of alcohol. Examples of sulfonylureas
include tolbutamide (Orinase), chlorpropamide (Diabinese), glyburide
(Micronase) and glipizide (Glucotrol). b. Biguanides lower blood
glucose levels by increasing the uptake and utilization of glucose
by muscle cells. They also reduce glucose production by the
liver. Biguanides are only effective in patients with Type II,
NIDDM, because their ability to function requires the presence
of insulin. Common side effects of biguanides include nausea,
vomiting, epigastric distress and diarrhea. There are also risks
of developing lactic acidosis and hepatic disease. Metformin
(Glucophage) is the most common type of biguanide. c. Glucosidase
inhibitors reduce the peak of blood glucose levels following
a meal by delaying and inhibiting the absorption of carbohydrates.
Glucosidase inhibitors work on both Type I, IDDM, and Type II,
NIDDM, as the inhibitors' effectiveness is not dependent on
the function of the pancreas. The major side effects are gastrointestinal,
including nausea, vomiting, abdominal pain and cramps. Acarbose
(Precose) is the most common glucosidase inhibitor.

II. Insulin

Patients with Type
I, IDDM, secrete little or no insulin and are dependent on external
sources of insulin to regulate their blood sugar. Insulin is
injected from once to several times daily to control the fluctuation
of blood glucose levels. Though effective, insulin injection
has numerous side effects, including hypoglycemic reactions,
local lipodystrophy, visual disturbance, edema, allergy, and
insulin resistance.

Note: In recent
years the use of Chinese herbs has become a more and more popular
option. To facilitate the understanding between drugs and herbs,
we have dedicated a whole section entitled the Drug-Herb Index
in our Clinical Manual of Oriental Medicine: Lotus Collection.
Our goal in creating this section is to point out the similarities
between the drug and the herbal treatments, so that a practitioner
may suggest herbal alternatives to their patients who are unable
to tolerate drugs or the side effects of drugs. This handy reference
includes a combination of more than 300 most commonly used brand
names and generic drug names. Knowing herbal alternatives to
drugs gives the practitioner another treatment option so they
can decide with their patients on the best therapy possible.

HERBAL TREATMENTS

Chinese herbs are
very effective in treating patients with Type II, NIDDM. When
prescribed correctly, Chinese herbs lower blood glucose levels,
manage common signs and symptoms, and treat the complications
of diabetes mellitus. Patients generally respond to herbal treatment
within three-to-four weeks, with significant reduction in blood
glucose levels and little fluctuation throughout the day. However,
some patients may require up to six-to-eight weeks. For patients
with Type I, IDDM, Chinese herbs are used in conjunction with
insulin to manage symptoms and complications. Chinese herbs
can also reduce the frequency and dosage of insulin injections.
However, it is important to keep in mind that herbs cannot replace
insulin, and patients with IDDM will still require insulin injections.

I. Equilibrium

Equilibrium is the
formula of choice for treating diabetes mellitus. From the perspective
of Western medicine, Equilibrium contains herbs with excellent
hypoglycemic effects, lowering blood glucose levels and reducing
synthesis of fatty tissues. In addition, Equilibrium contains
herbs that lower blood cholesterol levels and improve blood
circulation to the coronary arteries and peripheral parts of
the body--thus managing common complications of diabetes, such
as hyperlipidemia, atherosclerosis, coronary artery disease,
peripheral neuropathy, etc.

In terms of Chinese
therapeutic actions, Equilibrium nourishes Lung, Stomach and
Kidney Yin, clears heat, and dries dampness. It can be used
for patients with Upper, Middle or Lower Wasting (Xiao Ke) syndromes.
It effectively manages the three cardinal symptoms of Wasting
(Xiao Ke) syndrome: polydipsia, polyphagia and polyuria.

Equilibrium treats
both the cause and the complications of diabetes mellitus. American
ginseng (xi yang shen) greatly replenishes the vital essence
of the body and promotes the secretion of body fluids, to treat
polydipsia. Gypsum (shi gao) and anemarrhena (zhi mu) are a
pair commonly used to treat heat in the Middle Burner (Jiao).
They sedate Stomach fire and suppress appetite to relieve polyphagia.
Scrophularia (xuan shen) enters the Lungs, Stomach and Kidneys
to simultaneously replenish vital essence and clear heat. According
to Oriental Medicine, an elevated glucose level is equivalent
to excess retention of dampness in the body. Therefore, astragalus
(huang qi) and dioscorea (shan yao) are used to tonify Qi and
strengthen the Spleen to enhance its functions to dispel dampness.
With their aromatic properties, white atractylodes (bai zhu)
and atractylodes (cang zhu) strengthen the Spleen and directly
dry dampness. Salvia root (dan shen) and carthamus (hong hua)
invigorate blood circulation and enhance the overall effectiveness
of the herbs by improving micro-circulation. Activation of blood
circulation also reduces the risk of atherosclerosis by preventing
buildup of cholesterol on the inner walls of blood vessels.
Lastly, lotus embryo (lian zi xin) and lotus stamen (lian xu)
tonify the Kidney and control frequent urination.

II. Modification
of Herbal Treatment Based on Wasting (Xiao-Ke) Syndrome

Equilibrium is the
essential herbal formula used to lower blood glucose if the
patient shows no other significant complications. If diabetic
patients exhibit prominent signs and symptoms of Upper, Middle
or Lower Wasting (Xiao Ke) syndromes, treatment must be modified
by combining Equilibrium with the following formulas:

III. Modification
of Herbal Treatment Based on Complications

If diabetic patients
exhibit prominent signs and symptoms of complications, treatment
must be modified by combining Equilibrium with the following
formulas:

1. For patients
with high cholesterol, combine with Cholisma. 2. For patients
with hypertension, combine with Gentiana Complex or Gastrodia
Complex. 3. For patients with chronic buildup of cholesterol
leading to coronary artery disease, combine with Circulation.
4. For patients with blurred vision or vision impairment, combine
with Nourish. 5. For patients with impotence due to diabetic
complications, combine with Vitality For Men. 6. For patients
with recurrent urinary tract infections, combine with Gentiana
Complex.

CAUTIONS

Patients should
not stop using drug treatments abruptly as there is a risk of
hyperglycemia or diabetic ketoacidosis. Herbal and drug treatments
should overlap for 1 to 2 weeks before patients are to begin
tapering off drug treatments to ensure adequate control of blood
glucose levels.

Concurrent use of
drugs and herbal treatment may have synergistic effects on lowering
the blood glucose levels. During the transition period when
the patients take both drugs and herbs, their blood glucose
levels should be monitored at least twice daily to assess the
effectiveness of the treatment and to avoid hypoglycemia. Dosage
must be adjusted as needed to keep blood glucose within the
normal range. Herbal treatment may reduce the dosage and frequency
of insulin injections needed; however, it can never replace
insulin, especially in insulin dependent diabetes mellitus (IDDM)
patients. Patients with IDDM should always be treated with insulin,
or a combination of insulin and herbs.

LIFESTYLE INSTRUCTIONS

Lifestyle adjustments
are absolutely critical for short-term management and long-term
recovery of diabetes. Patients should be encouraged to engage
in regular daily exercise, sleep by 10 p.m. to enhance restoration
of Yin elements in the body, and eliminate sugar, carbohydrates
and caffeine from the diet. Additional dietary advice may be
useful based on the primary organ systems affected.

CLINICAL NOTES

For patients with
Type II, NIDDM, Equilibrium in combination with diet and exercise
provides excellent clinical results. Most patients will get
satisfactory clinical results within three-to-four weeks of
beginning herbal treatment. Maximum effectiveness may require
up to six-to-eight weeks of herbal treatment. Clinical effects
include a significant reduction in blood glucose levels and
less fluctuation throughout the day.

Diabetes mellitus
is defined simply as a rise in blood glucose levels. The clinical
manifestations of the disease, however, are much more complicated
than its definition. Patients with chronic diabetes mellitus
are frequently plagued by various complications, such as visual
disturbances, prolonged healing of wounds, frequent recurrences
of infections, impotence, etc., which must be addressed within
the overall treatment strategy.

CONCLUSION

Diagnosis and treatment
of the most common and complex endocrinologic disorder continues
to pose a challenge for health care practitioners. Diabetes
mellitus commonly may go undiagnosed as patients with early
stages of Type II, NIDDM are often asymptomatic. Also, as patients
with chronic Type II, NIDDM often have a wide variety of complications,
diabetes mellitus is frequently overlooked or mis-diagnosed.
Once the correct diagnosis is made, diabetes and its complications
can be effectively managed by both western drugs and herbal
remedies. In conclusion, herbal medicine offers a safe and effective
alternative for patients with diabetes mellitus.

CASE STUDIES

1. J.K., a 45-year-old
female, was 5'3" and weighed 160 pounds. She had urinary tract
infections once or twice each month within the last 12 months.
Her other symptoms and signs included constant thirst, increased
fluid intake, increased frequency and volume of urination. She
was diagnosed with diabetes mellitus after testing positive
for high levels of blood glucose. She was prescribed Equilibrium,
4 capsules TID before meals. Two weeks after the initial treatment,
she reported significant improvement of her signs and symptoms.
Two months after the initial treatment, her blood glucose levels
were within the ideal range. She did not have any urinary tract
infections during these two months. She continues to take Equilibrium,
4 capsules TID before meals.

Clinical Note:
Urinary tract infection is a common complication of chronic
diabetes. The frequency of infections, polydipsia and polyuria,
in combination with her age and body weight, indicated possible
diabetes. Prior to treating the urinary tract infection, her
blood glucose levels must first be tested to rule out diabetes.
In this case, persistent high levels of blood glucose levels
confirmed the diagnosis of diabetes mellitus. After treatment
with Equilibrium for two months, both symptoms and complications
of diabetes mellitus were under good control.

2. A.G., a 60-year-old
male, was 6'1" and weighed 280 pounds. He was always hungry
and ate two or three bowls of rice with every meal. He noticed
that his cuts or scratches required a longer period of time
to heal, sometimes up to one month. His diagnoses were diabetes
mellitus and high cholesterol. He was given Equilibrium, 4 capsules
TID for his diabetes, and Cholisma, 4 capsules TID for his cholesterol.
After taking the herbs for three months, his blood glucose levels
were within the ideal range and his cholesterol level dropped
from 260 to 220. His weight also dropped from 280 to 255 pounds.
He ate less and did not feel constantly hungry. He continues
to take both Equilibrium and Cholisma.

Clinical Note:
High cholesterol levels are a common complication of diabetes
mellitus. If untreated, high cholesterol levels can lead to
atherosclerosis, hypertension, coronary heart disease, angina,
and myocardial infarction. Therefore, effective treatment must
address both blood glucose levels and blood cholesterol levels.
In combination with dietary changes, this patient showed excellent
progress in reducing his blood glucose and cholesterol levels.

Professional
Use Only: This article is intended as a reference for licensed
health care practitioners, as professional training and expertise
are essential to the safe and effective use of the herbs. Similarly,
all herbal products are sold only to licensed health care practitioners.
The advantages and disadvantages of each herbal formula are
disclosed in full so both the doctors and the patients can make
informed decisions.

Structure
& Function Claims: The information is presented in this article
in an accurate, truthful and non- misleading manner. Claims
are supported by modern research and referenced accordingly
through the entire Article. Nonetheless, the FDA requires the
following statement: These statements have not been evaluated
by the Food and Drug Administration. These products are not
intended to diagnose, treat, cure or prevent any disease.

General
Disclaimer: Great care has been taken to maintain the accuracy
of the information contained in this article. The information
as presented in this Article is for educational purposes only.
We cannot anticipate all conditions under which this information
and our products, or the products of other manufacturers in
combination with our products, may be used. In view of ongoing
research, changes in government regulation, and the constant
flow of information relating to Chinese and western medicine,
the reader is urged to check with other sources for all up-to-date
information. We accept no responsibility for the results obtained
by the application of the information within this Article or
the safety and suitability of our products, either alone or
in combination with our products or with the products of other
manufacturers. Neither Lotus Herbs, Inc. nor the authors of
this Article can be held responsible for errors or for any consequences
arising from the use of the information herein.

John K. Chen,
Ph.D., Pharm.D., OMD, L.Ac. is a recognized authority on
western pharmacology and Chinese herbal medicine. He graduated
from the University of Southern California (USC) School of Pharmacy
and South Baylo University of Oriental Medicine. He also received
extensive postgraduate training in China specializing in herbology
and internal medicine.

Dr. Chen currently
teaches herbal medicine at USC, Chinese herbology at South Baylo
University, and western pharmacology at Yo San University and
Emperor's College. He is the Chair of the Herbal Medicine Committee
for the American Association of Acupuncture and Oriental Medicine (AAAOM)
and an herbal consultant for the California Association of Acupuncture
and Oriental Medicine (CAAOM).

Dr. John Chen is
the president and founder of
Lotus Herbs, and is available for medical consultations
through the Lotus Herbal Consultation Line.
Tel: (626) 916-1070;
Fax: (626) 917-7763;

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